Detecção e manejo de lesões de cárie ao redor de restaurações

Abstract

The study aim was to evaluate the impact of two visual criteria in the detection of caries lesions around restorations. Two visual criteria were used in this study: the International Dental Federation (FDI) criterion and the criterion developed by the International Caries Control and Classification System, called CARS (Caries Associated with Restorations and Sealants). The present thesis is based on a clinical trial that resulted in 3 studies. It was a randomized triple-blind, controlled trial with two parallel-groups: patients who received the assessment of the restorations and treatment decision according to the FDI (International Dental Federation) criteria - FDI group; and patients who received the assessment of the restorations and treatment decision according to the CARS - CARS group. A calibrated examiner performed the evaluations according to the randomized criterion. After establishing the treatment plan, patients were evaluated according to the second criterion for further analysis. Patients were treated according to the established plan according to the randomized criterion, and they were followed for up 38 months. The study 1 evaluated the influence of the two diagnostic criteria on the evaluation of caries lesions around restorations and treatment decisions on posterior teeth. It was concluded that the evaluation criteria used influenced on the decision of replacement or not the restorations. In addition, the use of the FDI criteria resulted in a less conservative approach compared to the CARS criteria. The study 2 evaluated the accuracy of the FDI and CARS criteria in detecting caries lesions around restorations. The CARS criteria were more accurate than the FDI criteria for detecting caries lesions around restorations. The FDI criteria were more likely to induce overtreatment. Yet, the study 3 evaluated the effect of using the two criteria under investigation on the treatment decision and longevity of the restorations. The restorations included in the clinical trial were assessed for the need for further interventions in the period of up to 36 months. It was concluded that the use of a criterion with a more conservative approach (CARS) for the detection of caries lesions around restorations has a similar effect in long term compared to a less conservative criterion (FDI). Finally, the present thesis concludes that the choice of the criterion to diagnose caries lesions around restorations has a direct impact on the treatment decision. The FDI criteria results in a less conservative approach, with a higher indication of restorative treatments. In addition, it is possible to ensure the quality and longevity of the restorations with a minimally invasive approach during the evaluation of caries lesions around the restorations.